[Antiplatelet agents and diabetes mellitus]

Abstract

Diabetes and more specially type 2 diabetes are a major cardiovascular risk factor. The high incidence of cardiovascular thromboischemic events in type 2 diabetic patients is explained by the development of atherothrombotic lesions and by their high rate of recurrence after angioplasty but also by their high thrombogenic potential due to the association of platelet hyperactivity, hypercoagulability and hypofibrinolysis. Platelets are involved at two different levels: their hyperreactiviy but also their lower sensitivity to antiplatelets agents and specially the two main aspirin and clopidogrel. That focuses the interest of the newer antiplatelet agents (prasugrel and ticagrelor) whose efficacy seems to be less affected in the sub-group of diabetics. Besides the increased thrombo-ischemic risk in diabetics: they are also characterized by an increased hemorrhagic risk (global hemorrhagic risk and risk conferred by anti-thrombotic treatments). Sub-group analysis clearly evidenced this increased hemorrhagic risk for aspirin and clopidogrel but seems to be much less for the newer antiplatelet agents (prasugrel and ticagrelor). Specific trials of primary and secondary prevention with these new agent are particularly awaited in the high risk populations specially diabetics.